Special Issue "ICD-11 Personality Disorder in Adolescents: Potentials and Pitfalls"

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Child and Adolescent Psychiatry".

Deadline for manuscript submissions: closed (25 April 2023) | Viewed by 4147

Special Issue Editors

Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark
Interests: personality disorders; psychotherapy research; mentalization-based theory; psychopathy; social learning theory; evolutionary psychology
Department of Psychology, Aalborg University, 9000 Aalborg, Denmark
Interests: personality disorder; dimensional approaches to personality disorder; personality; narrative identity; life story; mentalization; psychotherapy

Special Issue Information

Dear Colleagues,

In the ICD-11 diagnostical classification system, a dimensional approach to personality disorder (PD) is introduced. Here, impairments in both self and interpersonal functioning along a dimensional line from no disorder to severe PD is at the very heart of the definition of the disorder. With this Special Issue, we aim to set the scene for scholars to discuss strengths, opportunities and potential pitfalls related to conceptualizing, diagnosing and treating adolescents with PD within the ICD-11dimensional approach.

We invite both conceptual and empirical papers on the topic of, but not limited to:

1) Why, how, and when to integrate a more dimensional approach to classifying PD in adolescence. How do we distinguish personality disorder from typical developmental challenges?

2) Integrating a dimensional approach to the classification of PD in adolescence mental health service will inevitably request new and more fine-grained clinical skills. Do clinicians have this knowledge? How do we prepare clinicians for these new demands? 

3) Is there a risk that we base our judgement about personality pathology in adolescence on more general functional measures instead of core dysfunctions in self and interpersonal domains? Hence, are we, due to a more “loosely” defined dimensional approach, running the risk of confusing externalizing an internalizing pathology for personality pathology?

4) May the implementation of a dimensional approach to PD led to either an out-phasing of PD treatment or, on the contrary, over-diagnosing of PD in adolescents?

5) Do we know enough yet about the normal “self” and “interpersonal” mode of functioning in adolescents to use these core features as central features in the classification of PD?

6) What aspects of self and interpersonal functioning are particularly central in adolescents with PD within the ICD-11, and furthermore, what aspects of self–other understanding need further examination for adolescents specifically?

7) What and how do we improve and select assessment to diagnose PD within adolescents from a more dimensional perspective?

8) Does a more dimensional conceptualization of PD in adolescents effect the way we design and organize our treatment of PD?

Dr. Sune Bo
Dr. Majse Lind
Guest Editors

Manuscript Submission Information

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Keywords

  • personality disorder
  • ICD-11
  • adolescents
  • dimensionality
  • personality pathology

Published Papers (5 papers)

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Research

Article
Differential Diagnosis of ICD-11 Personality Disorder and Autism Spectrum Disorder in Adolescents
Children 2023, 10(6), 992; https://doi.org/10.3390/children10060992 - 01 Jun 2023
Viewed by 265
Abstract
The International Classification of Diseases 11th Revision (ICD-11) introduces fundamentally new diagnostic descriptions for personality disorder and autism spectrum disorder. Instead of the traditional categorical taxonomies, both personality disorder and autism spectrum disorder are described as being on a continuum. Accumulating research has [...] Read more.
The International Classification of Diseases 11th Revision (ICD-11) introduces fundamentally new diagnostic descriptions for personality disorder and autism spectrum disorder. Instead of the traditional categorical taxonomies, both personality disorder and autism spectrum disorder are described as being on a continuum. Accumulating research has pointed out that, in some cases, adolescents with autism spectrum disorder are at risk of being confused with having a personality disorder, which particularly applies to female adolescents. Case reports describe how adult autistic women struggled with social and identity roles as children and adolescents, using compensatory strategies such as social imitation and other types of camouflaging. Furthermore, some adolescents with autism display emotion dysregulation and self-injury. The ICD-11 recognizes that features of autism spectrum disorder may resemble features of personality disorder, but the two diagnoses have not yet been formally compared to one another. The present article therefore sought to outline and discuss the overlap and boundaries between the ICD-11 definitions of personality disorder and autism spectrum disorder and propose guiding principles that may assist practitioners in differential diagnosis with female adolescents. We specifically highlight how aspects of the self and interpersonal functioning along with emotional, cognitive, and behavioral manifestations may overlap across the two diagnoses. Restricted, repetitive, and inflexible patterns of behavior, interests, and activities are core features of autism spectrum disorder, which may be masked or less pronounced in female adolescents. Collecting a developmental history of the early presence or absence of autistic features is vital for a conclusive diagnosis, including features that are typically camouflaged in females. A number of future directions for research and clinical practice are proposed. Full article
(This article belongs to the Special Issue ICD-11 Personality Disorder in Adolescents: Potentials and Pitfalls)
Article
Narrative Identity within Mentalization-Based Group Therapy for Adolescents: A Feasibility Study
Children 2023, 10(5), 854; https://doi.org/10.3390/children10050854 - 10 May 2023
Viewed by 588
Abstract
Borderline personality disorder (BPD) is characterized by severe disturbances related to understanding oneself and other people and can be reliably detected and treated in adolescence. In this feasibility study, we aimed to focus on the features of, and changes in, narrative identity throughout [...] Read more.
Borderline personality disorder (BPD) is characterized by severe disturbances related to understanding oneself and other people and can be reliably detected and treated in adolescence. In this feasibility study, we aimed to focus on the features of, and changes in, narrative identity throughout the course of Mentalization-Based Treatment in Groups (MBT-G) for adolescents with BPD. Six female patients (M = 15.2, SD = 0.75) joined between 16 and 31 (M = 23.83) MBT g sessions. The narrated events within each session across sessions were coded for themes of agency and communion and the narrated reactions were coded for personality functioning. The patients and their parents also completed several self-report measures before and after therapy. Themes of diminished agency and communion were identified, with communion as the dominating theme. When comparing the patients’ first five sessions with their last five sessions, there was an increase in themes related to agency and decreased in communion. The narrated reactions were dominated by themes related to thwarted self-functioning and primarily identity, although intimacy was also present. Patients improved in terms of self-reported functioning and internalizing and externalizing behavior before and after end of treatment. The importance of narration in BPD (group) therapy is discussed alongside clinical implications. Full article
(This article belongs to the Special Issue ICD-11 Personality Disorder in Adolescents: Potentials and Pitfalls)
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Article
Mentalization in Typically and Atypically Developing Iranian Children and Its Associations with Age, Sex, and Externalizing/Internalizing Symptoms
Children 2023, 10(4), 657; https://doi.org/10.3390/children10040657 - 30 Mar 2023
Viewed by 591
Abstract
Mentalization refers to the ability to understand the mental states of oneself and those of others that motivate action and behavior. Mentalization has generally been linked to adaptive development and healthy functioning whereas diminished mentalization has been associated with maladaptive development and psychopathology. [...] Read more.
Mentalization refers to the ability to understand the mental states of oneself and those of others that motivate action and behavior. Mentalization has generally been linked to adaptive development and healthy functioning whereas diminished mentalization has been associated with maladaptive development and psychopathology. The vast majority of research on mentalization and developmental trajectories, however, is based on Western countries. The overall aim of this study was therefore to examine mentalizing abilities in a novel sample of 153 typically developing and atypically developing Iranian children (Mage = 9.41, SDage = 1.10, Range = 8–11, 54.2% females) recruited from a primary school and health clinic in Tehran. The children completed semi-structured interviews that were later transcribed and coded for mentalization. The parents provided reports on internalizing and externalizing symptoms, demographic information, and all formal diagnoses of the children. The results pointed at general age and sex differences across the two groups. Older children showed more adaptive mentalization compared to the younger children; boys and girls used different mentalizing strategies when facing difficult situations. The typically developing children were better at mentalizing than the atypically developing children. Finally, more adaptive mentalization was associated with lower externalizing and internalizing symptoms among all children. The findings of this study contributes with expanding mentalization research to also encompass non-Western populations and the results hold crucial educational and therapeutic implications. Full article
(This article belongs to the Special Issue ICD-11 Personality Disorder in Adolescents: Potentials and Pitfalls)
Article
Maladaptive Self- and Interpersonal Functioning Increments General Psychiatric Severity in the Association with Adolescent Personality Pathology
Children 2023, 10(1), 120; https://doi.org/10.3390/children10010120 - 06 Jan 2023
Cited by 1 | Viewed by 792
Abstract
Dimensionalized diagnostic systems, especially the entry criterion of maladaptive self and interpersonal functioning, hold particular advantages for the downward extension of personality pathology to young persons, but require conceptual clarification. The current study evaluated the distinctiveness of maladaptive self and interpersonal functioning by [...] Read more.
Dimensionalized diagnostic systems, especially the entry criterion of maladaptive self and interpersonal functioning, hold particular advantages for the downward extension of personality pathology to young persons, but require conceptual clarification. The current study evaluated the distinctiveness of maladaptive self and interpersonal functioning by examining its incremental value over and above general psychiatric severity in the association with personality pathology. A community sample of N = 419 youth (50.4% female; Mage = 11.91, SD = 1.19) between the ages of 10 and 14 completed measures of maladaptive self- and interpersonal functioning, general psychiatric severity (internalizing–externalizing spectrum), and personality pathology. Results showed that, as expected, maladaptive self- and interpersonal functioning incremented general psychiatric severity in the association with personality pathology in adolescents. Results contribute to the literature base illustrating the value of the entry criterion of the ICD-11 and AMPD diagnostic system. Full article
(This article belongs to the Special Issue ICD-11 Personality Disorder in Adolescents: Potentials and Pitfalls)
Article
Adapting Short-Term Mentalization-Based Therapy to ICD-11 Personality Disorder in Adolescents
Children 2023, 10(1), 93; https://doi.org/10.3390/children10010093 - 02 Jan 2023
Viewed by 1157
Abstract
Following the introduction of the 11th revision of the International Classification of Diseases (ICD-11), adolescents can now be diagnosed with a personality disorder based on severity ranging from mild to moderate to severe. This dimensional model has potential implications for treatment, as it [...] Read more.
Following the introduction of the 11th revision of the International Classification of Diseases (ICD-11), adolescents can now be diagnosed with a personality disorder based on severity ranging from mild to moderate to severe. This dimensional model has potential implications for treatment, as it allows clinicians and researchers to search for effective treatments targeting adolescents at different severity levels rather than offering all patients the same treatment. In this conceptual paper, we propose that the short-term mentalization-based therapy (MBT) program, originally developed to treat adults with borderline personality disorder (BPD), has potential clinical advantages for adolescents with ICD-11 personality disorder at the mild to moderate severity level. The short-term MBT program is a 5-month structured treatment approach including individual therapy, combined psychotherapy with the individual therapist also being one of the group therapists, and closed-group therapy to enhance cohesion and a feeling of security. The purpose of this paper is to make a case for the use of this format, as opposed to the traditional long-term MBT format, for adolescents with BPD. Future research should include large-scale randomized clinical trials powered to assess patient-important outcomes. Full article
(This article belongs to the Special Issue ICD-11 Personality Disorder in Adolescents: Potentials and Pitfalls)
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